Amputation—the complete or partial removal of a limb—is the most conventional and common approach to treating severe Critical Limb Ischemia (CLI), particularly for older individuals. CLI is anadvanced form of peripheral arterial disease. As recently as 2017, 70% of CLI patients received amputation before any intervention. Unfortunately, after amputation, most patients deteriorate rapidly – according to a recent study on amputation for chronic CLI. In this interview, Dr. Rundback explains other alternatives to amputation for patients with peripheral arterial disease or critical limb ischemia.
What Can Patients with PAD Do to Prevent Ampuation and the Development of CLI?
Peripheral arterial disease (PAD) represents atherosclerosis or blockage of the arteries in the legs. Specifically, it affects the heart arteries, causing heart attacks, and the neck arteries, causing strokes. PAD is a spectrum of diseases that may be asymptomatic or can progress to pain with exertion, pain at night (which wakes people from sleep), or in the worst-case scenarios, pain at rest, ulceration, and wounds, which may result in amputation. If PAD worsens or progresses, this is called Critical Limb Ischemia (CLI)
The goal is to avoid the progression of peripheral arterial disease to the point where there are non-healing wounds. In high risk patients, such as patients with diabetes and chronic kidney disease, this requires frequent foot checks for early identification of wounds before they become worse. You can see your doctor and get referred to a vascular specialist.
For patients with lesser stages of peripheral arterial disease, we encourage ambulation, walking, and healthy habits. And most importantly, you need to control risk factors, including diabetes, high blood pressure, high cholesterol, and smoking, so these do not contribute to the worsening of the disease.
How important is a PAD screening to help prevent amputation down the road?
September is “PAD screening month,” but every month should be PAD screening month. PAD screening is a method of just coming in before you have any symptoms to see if there’s any evidence of Peripheral Arterial Disease or blockage in leg arteries.
This is important for two reasons.
- Early identification of blockage in leg arteries may allow appropriate treatment to help prevent the progression of the disease. Importantly, that may allow us to recognize the disease early on that would otherwise put people at risk of the disease progressing and perhaps getting in a situation where amputation might be necessary.
- Identifying atherosclerosis or hardening of the arteries and leg arteries is a coronary equivalent, a marker that there’s a higher risk of getting heart attacks and strokes in patients in whom PAD screening shows disease, and therefore who need to be treated much more aggressively with medical therapy to control atherosclerosis.
What Alternative Treatment Options are Available for Patients with PAD and CLI?
I think, for the most part, minimally invasive endovascular management, in proper hands, should replace surgical therapies as a first-line approach for patients. Patients with critical limb ischemia often have blockages in the small arteries due to diabetes, chronic kidney disease, hypertension, and poor cholesterol management. Because these blockages involve the small arteries, they’re really not very often amenable to surgical bypass.
Surgical bypass is associated with a much higher rate of complications, longer recovery, and discomfort. Usually, using minimally invasive techniques, threading catheters through the arteries restores flow directly through the arteries to the patient’s wound. We’re able to prevent amputation in more than 80% of cases, even in patients who have had failure elsewhere.
How successful are the physicians at American Endovascular at saving limbs after amputation was recommended?
We’re able to prevent amputation these days in more than 80% of patients who have diabetic foot wounds and wounds in the feet due to poor circulation, even if prior amputation was recommended. This is due to the fact that we have developed very sophisticated methods to open up the very small arteries that are blocked that lead directly to these wounds. If you’re told that amputation is necessary, we encourage you to see a physician at American Endovascular & Amputation Prevention.
Request a Consultation with Dr. Rundback
If you have signs of PAD, take our screening form to see if you’re at risk for developing CLI. You can also request a consultation with Dr. John Rundbak at NJ Endovascular & Amputation Prevention to discuss your symptoms.